title: Outcomes after incidental durotomy during first-time lumbar discectomy.
abstract: OBJECTIVE
  Incidental durotomy is an infrequent but well-recognized complication during lumbar disc surgery. The effect of a durotomy on long-term outcomes is, however, controversial. The authors sought to examine whether the occurrence of durotomy during surgery impacts long-term clinical outcome.
  
  
  METHODS
  Spine Patient Outcomes Research Trial (SPORT) participants who had a confirmed diagnosis of intervertebral disc herniation and were undergoing standard first-time open discectomy were followed up at 6 weeks and at 3, 6, and 12 months after surgery and annually thereafter at 13 spine clinics in 11 US states. Patient data from this prospectively gathered database were reviewed. As of May 2009, the mean (± SD) duration of follow-up among all of the intervertebral disc herniation patients whose data were analyzed was 41.5 ± 14.5 months (41.4 months in those with no durotomy vs 40.2 months in those with durotomy, p < 0.68). The median duration of follow-up among all of these patients was 47 months (range 1-95 months).
  
  
  RESULTS
  A total of 799 patients underwent first-time lumbar discectomy. There was an incidental durotomy in 25 (3.1%) of these cases. There were no significant differences between the durotomy and no-durotomy groups with respect to age, sex, race, body mass index, herniation level or type, or the prevalence of smoking, diabetes, or hypertension. When outcome differences between the groups were analyzed, the durotomy group was found to have significantly increased operative duration, operative blood loss, and length of inpatient stay. However, there were no significant differences in incidence rates for nerve root injury, postoperative mortality, additional surgeries, or SF-36 scores for Bodily Pain or Physical Function, or Oswestry Disability Index scores at 1, 2, 3, or 4 years.
  
  
  CONCLUSIONS
  Incidental durotomy during first-time lumbar discectomy does not appear to impact long-term outcome in affected patients.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03766, USA. atman.desai@hitchcock.org
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
authors.forename: Perry A
authors.initials: PA
authors.lastname: Ball
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.forename: Jon D
authors.initials: JD
authors.lastname: Lurie
authors.forename: Sohail K
authors.initials: SK
authors.lastname: Mirza
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: James N
authors.initials: JN
authors.lastname: Weinstein
mesh_terms: D000328:Adult; D019540:Area Under Curve; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D017586:Diskectomy / Q000009:adverse effects*; D004388:Dura Mater / Q000293:injuries*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D022125:Lacerations / Q000209:etiology*; D007902:Length of Stay / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D013997:Time Factors; D016896:Treatment Outcome